OUTCOME OF PATIENTS WITH AGGRESSIVE B‐CELL LYMPHOMA WHO FAILED TO PROCEED TO OR RELAPSED AFTER HIGH DOSE CHEMOTHERAPY AND AUTOLOGOUS HEMATOPOIETIC CELL TRANSPLANTATION

Abstract

Background: Patients with high-risk or relapsed aggressive lymphoma are usually treated with high dose chemotherapy (HDT) and autologous hematopoietic cell transplantation (auto-HCT). Aim: We evaluated patients who were referred to auto-HCT and who failed to proceed to or relapsed after auto-HCT. Methods: We evaluated data from 101 consecutive patients with aggressive B-cell lymphoma: DLBCL (n= 86) and PMBL (n=15), who were planned for HDT and auto-HCT at our institution between 2012 and 2017 including 45 female and 56 male, median age (range) of 49 (20-69), clinical stage III/IV in 85 (85%) pts. Results: After first-line treatment, CR and PR was achieved in 51 (50%) and 43 (43%), respectively. Twenty three patients (23%) were not eligible for transplant: 7 pts failed stem cell mobilization, and 16 patients progressed before transplantation. 78 pts underwent HDT and auto-HCT: 21 pts in the first remission, and 57 pts after a median of 2 (2-4) lines of treatment. At transplant, 46 (60%) and 31 (40%) patients were in CR, and PR, respectively. Relapse after transplant occurred in 30 (38%) patients including 6 pts in first remission and 24 pts in subsequent remission (p=0.24), and 12 (26%) pts in CR and 18 (58%) in PR (56%) (p=0.003). The HR for progression in pts with response less than CR was 2.89 (95%CI: 1.51, 6.66) compared to pts with CR at transplant. With a median (range) PFS of 20 months (0-79), 1-year PFS was 66% (95%CI: 56%, 76%). Median (range) PFS for patients who relapsed post-transplant was 3 (0-40) months. With a median (range) follow up of 21 (0-79) months, 1- year OS for all transplanted patients was 69% (95%CI: 59%, 79%). Median (range) OS for pts who relapsed after auto-HCT was 6 (0-40) months.Conclusion: Around 20% of patients with high-risk or relapsed aggressive B-cell lymphoma were not able to proceed to HDT/auto-HCT, and around 40% of those who did, progressed after transplantation. Non-CR at transplant increased the risk of progression after transplantation. Taken together, 60% of patients with aggressive B-cell lymphoma referred to HDT/auto-HCT at our institution might be candidates for novel therapies. Keywords: diffuse large B-cell lymphoma (DLBCL); high-dose therapy (HDT). Disclosures: Romejko-Jarosinska, J: Honoraria: Roche, Takeda; Other Remuneration: Travel grant- Takeda, Servier. Paszkiewicz-Kozik, E: Honoraria: Roche, Takeda; Other Remuneration: Travel grant- Roche. Popławska, L: Other Remuneration: Travel grant- Roche. Targonski, L: Other Remuneration: Travel grant- Roche, Celgena. Szymanski, M: Other Remuneration: Travel grant- Roche. Walewski, J: Consultant Advisory Role: Roche, Celgene, Takeda, Janssen-Cilag, Servier, Amgen, Incyte Abbvie; Honoraria: Roche, Takeda, Celgene Janssen Cilag, Servier; Research Funding: Roche, GSK/Novartis, Takeda Janssen Cilag; Other Remuneration: Travel grant- Roche.